Trends in Sepsis: evidence from a population-based study of 13 994 hospitalizations in the Abruzzo Region, Southern Italy

Background : Sepsis remains a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Despite international guidelines and diagnostic criteria, real-world variability in coding, treatment, and outcomes persist. This retrospective study analyzed 13,994 hospital admissions between 2016 and 2024 to evaluate the burden of sepsis, temporal trends, clinical outcomes, and healthcare costs within a regional health system. Methods: Hospitalization data across four local health authorities (ASL 201–204) over an 8-year period were analyzed. Sepsis cases were identified using validated ICD-9-CM-based algorithms and classified into four groups according to available microbiological coding: Gram-positive, Gram-negative, anaerobic and unspecified. Variables included patient demographics, length of stay, costs, outcomes (in-hospital and post-discharge mortality) and presence of septic shock. Comparative analyses were conducted using descriptive statistical methods and One-way ANOVA test and chi-squared tests were applied to evaluate the significance of differences. Results: The dataset included 13,994 sepsis cases, with the largest subgroup being 'unspecified' (48.0%). Among cases specified etiology, anaerobic sepsis, though rare (0.7%) was associated with higher in-hospital mortality (45.5%) and economic burden (avg. € 8,563). Mortality remained high at 6 and 12 months across all types, exceeding 50% post-discharge. Differences across microbiological groups should be interpreted cautiously given the high proportion of cases without organism-specific coding. Discussion: These findings underscore the clinical and economic impact of sepsis in hospitalized patients, especially among those with anaerobic and Gram-negative infections. The high mortality rate at 6–12 months highlights the need for structured follow-up programs. This analysis offers a detailed real-world snapshot of sepsis over nearly a decade. Sepsis represents a substantial clinical and economic burden within the regional healthcare system, with persistently elevated short- and mid-term mortality. Incomplete organism-level documentation limits direct etiologic comparisons and highlights the need for improved integration between clinical, microbiological, and administrative data systems. Future research should integrate clinical variables and lab results to enable risk stratification and intervention planning.